(Updated January 2012)
Emergency Contraception Patient Scripts
General Facts on Emergency Contraception
What Should Happen…
Patient: I have an emergency, the condom broke last night and it is the only method of protection my boyfriend and I use. What are my options to prevent pregnancy?
Pharmacist: Emergency contraception (EC) is a great option for you. EC is effective up to 120 hours or five days after unprotected sex.1
Patient: How does EC work?
Pharmacist: EC will be more effective the sooner it is taken.1,2 EC delays or stops ovulation (the release of an egg that can be fertilized by sperm) and will often prevent pregnancy in the event that regular contraceptive methods fail or in the case of sexual assault.1-3 EC can be used for up to 120 hours or five days after unprotected sex1, but for greatest effectiveness it should always be taken as soon as possible after sex.
Patient: Will EC work if I am already pregnant?
Pharmacist: No, EC is not an "abortion pill", and it will not be effective for women who are currently pregnant.4 It is only effective if you are not yet pregnant.
Patient: How do I know it is safe?
Pharmacist: EC is very safe and effective.2 Many prominent organizations endorse the use and safety of EC such as the American College of Obstetricians and Gynecologists, the US Food and Drug Administration, the World Health Organization, and the American Academy of Pediatrics.3,5 EC pills can reduce the risk of pregnancy by 52 to 100%, depending on how soon you take it, the brand of EC, and when during your cycle you have unprotected sex.1,6 ella™ is more effective on the fourth and fifth day after sex than Plan B® One-Step, Levonorgestrel, or Next Choice™ after sex.6 Additionally, emergency insertion of the Copper T IUD reduces the risk of pregnancy by more than 99%.6,7
Patient: What types of EC are available to me?
Pharmacist: There are several methods of EC available to you in the US. 1) Plan B One-Step, Levonorgestrel, Next Choice, and ella; 2) high doses of specified birth control pills; and 3) the Copper T IUD.7
The Copper T IUD can be used as an EC method. The Copper T IUD is an intrauterine device that can be inserted up to five days after unprotected sex by a trained clinician, but not pharmacists, to prevent pregnancy.2,6 In addition, the Copper T IUD used to prevent pregnancy for up to 10 years.6-8
Always, call ahead to your local pharmacy to find out what products are available to you.
Patient: What are the advantages and disadvantages of the EC methods?
Pharmacist: The main advantage of EC is that it is your last chance to prevent pregnancy after unprotected sex. Both EC pills and Copper T IUDs are methods of emergency contraception.6,7 However, a Copper T IUD requires a visit to the doctor for placement, and eventually, removal by a trained health care provider.
The main disadvantages for patients using EC pills are the possibility of unwanted side effects.2,6-7 While most patients using EC pills experience little to no side effects, the most frequently reported side effects are nausea and vomiting.2,8 Patients who experience more vomiting and nausea are those who take specified, higher doses of regular birth control pills as EC.1,3 Other, less frequent, side effects may include dizziness, breast tenderness, and irregular bleeding.1,6-7,9-10 None of the methods protect against sexually transmitted infections.
Patient: Can I use my regular birth control pills as EC?
Pharmacist: Although these are not recommended as the first approach because they are less effective than other emergency contraception pills, regular birth control pills can be used as EC as directed by a medical provider. If Plan B One-Step, Levonorgestrel, ella, or Next Choice are not available, ask your provider for a prescription for regular for birth control pills to be taken as EC. If you have birth control pills do not use them for EC unless your provider directs you to do so.
Patient: When will my period return after taking EC?
Pharmacist: Your period should return about the same time as you would normally expect it and certainly within the next month.11 However, in some cases it may come as much as one week sooner or one week later than usual.10,11 Additionally, depending on when EC treatment is taken, it can prolong or shorten your cycle.
Patient: What should I do if my period does not return within the next month?
Pharmacist: If you do not have your period within the next month it is important to purchase a pregnancy test and make an appointment with your healthcare provider for further tests.10,11
What You Should Know
- EC is very safe in reducing the risk of pregnancy.
- Types of EC: regular birth control pills, Copper T IUD, and specified EC pills.
- The sooner you take EC, the more effective it will be in preventing pregnancy.
Customer Access, Rights & Grievances
What Should Happen
Patient: Can I purchase EC here?
Pharmacist: Yes, but there are some different procedures depending on your age. How old are you?
Patient: I am 18 years old.
Pharmacist: Anyone 17 years and older, presenting with a valid driver's license or other government-issued ID, in the US can purchase Next Choice, Levonorgestrel and Plan B One-Step over-the-counter(OTC) without a prescription.2,8 Younger women can purchase Next Choice, Levonorgestrel, and Plan B One-Step with a valid prescription in the US. To purchase ella, regardless of age, you must have a prescription.2,6,8,12
Patient: Can my younger sister purchase EC, she is 16 years old?
Pharmacist: Yes, with a valid prescription, she can purchase Next Choice, Levonorgestrel and Plan B One-Step, but she cannot purchase EC over-the-counter.7 All customers need a prescription to purchase ella regardless of age.2,6,8,12
Patient: Does she need my parent's permission?
Pharmacist: No, it is not required that she receive permission from your parents. As long as she has a valid prescription for EC, she has the right to purchase it.
You have the right to purchase EC with a proper prescription (if necessary) and ask questions of the pharmacist about different EC options available to you.6,7 As a customer with a proper prescription and ID, it is your right to file grievance if you are denied the chance to purchase Next Choice, Plan B One-Step, Levonorgestrel, or ella, if these products are in stock.
Patient: Can I purchase more than one EC pack at one time?
Pharmacist: If you are buying EC over the counter, you are allowed to buy as many packs of EC as you want. If you are using a prescription, you can buy up to the number of packs of EC specified in your prescription. If you are using insurance, you may be limited by how many packs your insurance will cover. .2,6,8,12 Clinicians recommend that you have supply of EC on hand in the event that your regular birth control method fails.
What You Should Know
- Regardless of age, women must have a prescription for ella.
- Women and men, 17 years, and older, with ID, can purchase Next Choice, Levonorgestrel, and Plan B One-Step without a prescription. Younger women will be required to obtain a prescription.
- If you are denied the chance to purchase EC, you have the right to file grievance with the store or with your state's Board of Pharmacy.
Men and Emergency Contraception
What Should Happen…
Patient: Can I buy EC for my girlfriend?
Pharmacist: How old are you?
Patient: I am 16 years old.
Pharmacist: Since you are under 17, a prescription written for your girlfriend will be necessary to get EC. A prescription for EC cannot be written for a male. If you were 17 years old or older and had proper ID, you could purchase an over-the-counter EC product for your girlfriend. For men 17 and older, the same customer rights apply when purchasing EC.
What You Should Know
- Men, 17 years and older, can purchase Next Choice, Levonorgestrel, and Plan B One-Step without a prescription.
- Prescriptions for ella, Plan B One-Step, Levonorgestrel, and Next Choice are only available to women.
- Society for Adolescent Medicine. Provision of emergency contraception to adolescents: position paper of the Society for Adolescent Medicine. Journal of Adolescent Health 2004; 35:66-70.
- American College of Obstetricians and Gynecologists. Emergency contraception. ACOG Practice Bulletin: Clinical Management Guidelines, December 2005 (#69).
- Croxatto HB, Devoto L, Durand M, et al. Mechanism of action of hormonal preparations used for emergency contraception: a review of the literature. Contraception. 2001;63:111–21.
- Ellertson C et al. Extending the time limit for starting the Yuzpe regimen of emergency contraception to 120 hours. Obstetrics & Gynecology 2003; 101:1168-1171.
- Kahn JG et al. Pregnancies averted among U.S. teenagers by the use of contraceptives. Family Planning Perspectives 1999; 31:29-34.
- Trussell J, Raymond EG. Emergency Contraception: A Last Chance to Prevent Unintended Pregnancy. November 2011. Available at http://ec.princeton.edu/questions/ec-review.pdf
- The Emergency Contraception Website http://ec.princeton.edu/questions/dose.html
- Advocates for Youth: Resources for Professionals http://www.advocatesforyouth.org/emergency-contraception-resources-for-professionals
- Selected practice recommendations for contraceptive use. Second Edition. Geneva: World Health Organization, 2004
- Van Look PFA, Stewart F. Emergency contraception. In: Hatcher RA et al. Contraceptive Technology. 17th rev. edition. New York, NY: Ardent Media, 1998.
- Raymond EG, Goldberg A, Trussell J, Hays M, Roach E, Taylor D. Bleeding patterns after use of levonorgestrel emergency contraceptive pills. Contraception. 2006;73:376‐81. Erratum.Contraception. 2006;74:349‐50. Erratum. Contraception. 2007;75:476‐7
- Gainer E, Kenfack B, Mboudou E, Doh AS, Bouyer J. Menstrual bleeding patterns following levonorgestrel emergency contraception. Contraception. 2006;74:118‐24.
- EC Bill of Rights http://blog.thenationalcampaign.org/pregnant_pause/2010/09/ec-bill-of-rights.php